TOPS payment v2

Toronto Oral Pathology Services (TOPS)

Dr. Grace Bradley, Dr. Justin Bubola, Dr. Deepika Chugh,
Dr. Iona Leong, Dr. Marco Magalhaes

Faculty of Dentistry, University of Toronto
124 Edward Street, RM 314
Toronto, ON M5G 1G6

Laboratory Number*

Doctor's Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email for electronic receipt*

example@example.com

Phone Number*

Please enter a valid phone number.

Oral Path Products*

Laboratory Fee

$110.00CAD Quantity

Total

$0.00CAD

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